Provider Demographics
NPI:1609192608
Name:MATHUR, JAY (DO)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:MATHUR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 639295
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9295
Mailing Address - Country:US
Mailing Address - Phone:484-346-1692
Mailing Address - Fax:588-618-6655
Practice Address - Street 1:11835 QUEENS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7211
Practice Address - Country:US
Practice Address - Phone:646-722-7610
Practice Address - Fax:347-535-3970
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT50077207R00000X, 207R00000X
NY269640207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program